Inquiry form to a teacher

Input must be made for the items marked required. Be sure to input information for these items.

* Use an e-mail address at which you can receive e-mail from a computer.
* Enter your telephone number, because a reply may be made by telephone if an e-mail cannot be sent to you.

Address	Makoto Takizawa
Full namerequired
E-mail addressrequired
Telephone numberrequired
Inquiry textrequired

Change the image

Input the alphanumeric characters displayed on the image.
If you cannot read the characters because of displacement, click “Change the image” a few times and select one with characters you can read.

1. Inquiry text input
2. Input text confirmation
3. Transmission completion & transmission of confirmation e-mail